The short version
- Perimenopause can start years before periods stop, with irregular cycles the first clue
- Blood tests rarely diagnose it — the pattern of symptoms does
- Symptoms beyond hot flushes are common and often treatable
- Bone and heart health both change at menopause and are worth reviewing
Perimenopause comes first, and lasts longer than people expect
The transition typically begins in the mid-forties and can run for several years before periods stop altogether. Cycles become irregular — shorter, longer, heavier, skipped — and symptoms often arrive well before anyone connects them to hormones.
Menopause itself is defined retrospectively: twelve consecutive months without a period.
The symptoms that get missed
- Sleep — waking at 3am, often with night sweats, sometimes without
- Mood — irritability, anxiety, low mood, a shorter fuse than usual
- Cognition — word-finding difficulty and poor concentration, which is real and usually temporary
- Joint and muscle aches, frequently attributed to age
- Genitourinary symptoms — vaginal dryness, pain with sex, urinary urgency and recurrent urinary infections. These tend to worsen over time rather than settle, and they respond well to treatment
- Heavy or unpredictable bleeding during perimenopause
Any bleeding after menopause is different and should be assessed promptly, every time.
Why blood tests usually do not help
Hormone levels fluctuate wildly during perimenopause, so a single test often reflects the day rather than the stage. In women over 45 with typical symptoms, diagnosis is made on the pattern, not the pathology.
Testing is more useful in specific situations — under 45, after certain surgery or cancer treatment, or where another cause such as thyroid disease needs excluding. Your GP will arrange what is relevant to you.
What treatment looks like
Options include menopausal hormone therapy, non-hormonal prescription options, and local treatments specifically for genitourinary symptoms — which are effective and suit many people who cannot or prefer not to use systemic therapy.
Australian law prevents naming prescription medicines in public health information, so the specifics belong in a consultation. What is worth knowing is that the risk–benefit picture is individual: your age, how long since menopause, your personal and family history all change the answer, and the blanket advice many women received twenty years ago does not reflect current understanding.
Non-drug measures matter too: strength training, sleep routines, reducing alcohol, and cognitive behavioural approaches all have evidence behind them for specific symptoms.
The things to check while you are there
Bone density falls fastest in the years around menopause, and cardiovascular risk rises. A menopause appointment is a good moment to review blood pressure, cholesterol, vitamin D, weight and activity, and to check whether your cervical screening and breast screening are up to date.
Ask for a long appointment — this rarely fits into fifteen minutes. See women's health.
Common questions
Usually not. Hormone levels fluctuate during perimenopause, so diagnosis in women over 45 rests on the pattern of symptoms. Testing is more useful in specific circumstances.
The risk and benefit picture is individual and depends on your age, time since menopause and personal history. It is a conversation to have with your GP rather than a blanket answer.
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